Healthcare Provider Details

I. General information

NPI: 1336933118
Provider Name (Legal Business Name): AARON GEORGE CISNEROS LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2025
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10912 JERSEY BLVD
RANCHO CUCAMONGA CA
91730-5102
US

IV. Provider business mailing address

154-A W. FOOTHILL BLVD. P.O. BOX # 221
UPLAND CA
91786
US

V. Phone/Fax

Practice location:
  • Phone: 909-466-7789
  • Fax:
Mailing address:
  • Phone: 909-957-1192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number150104
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: